Implementation

• High Alert: Lidocaine is readily absorbed through mucous membranes. Inadvertent overdosage of lidocaine jelly and spray has resulted in patient harm or death from neurologic and/or cardiac toxicity. Do not exceed recommended dosages

• Throat Spray: Ensure that gag reflex is intact before allowing patient to drink or eat

• IM: IM injections are recommended only when ECG monitoring is not available and benefits outweigh risks. Administer IM injections only into deltoid muscle while frequently aspirating to prevent IV injection

• Direct IV:
Only 1% and 2% solutions are used for direct IV injection.
Diluent: Administer undiluted.

• Rate:
Administer loading dose over 2–3 min. Follow by IV continuous infusion

• Continuous Infusion:
Diluent: Lidocaine vials need to be further diluted. Dilute 2 g of lidocaine in 250 ml or 500 ml of D5W or 0.9% NaCl. Admixed infusion stable for 24 hr at room temperature. Premixed infusions are already diluted and ready to use.
Concentration: 4–8 mg/ml

• Rate:
See Route/Dosage section. Administer via infusion pump for accurate dose

• Y-Site Compatibility:

» alteplase

» amikacin

» aminophylline

» amiodarone

» argatroban

» atropine

» aztreonam

» bivalirudin

» bumetanide

» calcium chloride

» calcium gluconate

» cefazolin

» cefotaxime

» cefoxitin

» ceftazidime

» ceftizoxime

» ceftriaxone

» cefuroxime

» chloramphenicol

» cimetidine

» ciprofloxacin

» cisatracurium

» clindamycin

» cyclosporine

» daptomycin

» dexamethasone sodium phosphate

» dexmedetomidine

» digoxin

» diltiazem

» diphenhydramine

» dobutamine

» dopamine

» doxycycline

» enalaprilat

» epinephrine

» eptifibatide

» ertapenem

» erythromycin

» esmolol

» etomidate

» famotidine

» fenoldopam

» fentanyl

» fluconazole

» furosemide

» gentamicin

» granisetron

» haloperidol

» heparin

» hydrocortisone sodium succinate

» imipenem/cilastatin

» inamrinone

» insulin

» isoproterenol

» ketorolac

» labetalol

» levofloxacin

» linezolid

» lorazepam

» magnesium sulfate

» meperidine

» methylprednisolone sodium succinate

» metoclopramide

» metoprolol

» metronidazole

» micafungin

» midazolam

» morphine

» nafcillin

» nicardipine

» nitroglycerin

» nitroprusside

» norepinephrine

» ondansetron

» palonosetron

» penicillin G potassium

» phenylephrine

» phytonadione

» piperacillin/tazobactam

» potassium chloride

» procainamide

» prochlorperazine

» promethazine

» propofol

» propranolol

» protamine

» quinupristin/dalfopristin

» ranitidine

» remifentanil

» sodium bicarbonate

» streptokinase

» tacrolimus

» theophylline

» ticarcillin/clavulanate

» tigecycline

» tirofiban

» tobramycin

» vancomycin

» vasopressin

» verapamil

» vitamin B complex with C

» voriconazole

» warfarin

• Y-Site Incompatibility:

» acyclovir

» amphotericin B cholesteryl sulfate complex

» caspofungin

» diazepam

» ganciclovir

» lansoprazole

» pantoprazole

» phenytoin

» thiopental

» trimethoprim/sulfamethoxazole

• Infiltration: Lidocaine with epinephrine may be used to minimize systemic absorption and prolong local anesthesia

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